Liu Yuyang, Tan Yaheng, Wan Jun, Xiao Yangchun, Chen Qiwen, Zheng Yuxin, Tian Chengli, Wang Xinyue, Xu Wenhao, Yu Xueying, Lu Dianxiang
Center for Evidence-based Medicine, Clinical Medical College and Affiliated Hospital of Chengdu University, Chengdu, Sichuan, China.
Zunyi Medical University, Zunyi, China.
PLoS One. 2025 Jul 16;20(7):e0326494. doi: 10.1371/journal.pone.0326494. eCollection 2025.
High blood pressure frequently occurs in the setting of acute stroke and is associated with worse prognoses. However, it is still uncertain whether initiating blood pressure-lowering therapy in the prehospital phase after stroke onset can enhance outcomes for patients with undifferentiated acute stroke.
We conducted a search of the PubMed, Embase, and Cochrane databases to identify randomized controlled trials investigating prehospital blood pressure lowering interventions for presumed ultra-acute stroke (within <6 hours). The primary outcome analyzed was the 90-day modified Rankin Scale (mRS), while mortality was considered a secondary outcome.
This meta-analysis included four studies with a total of 3912 patients. The pooled data revealed no significant difference in poor functional outcomes at 90 days (RR = 0.97, 95% CI: 0.92-1.02) or mortality rates (RR = 1.02, 95% CI: 0.90-1.15) between the group receiving blood pressure lowering treatment and the control or placebo group.
In patients with ultra-acute presumed stroke, prehospital blood pressure lowering treatment within 6 hours of stroke did not improve clinical outcomes (PROSPERO: CRD42024557505).
高血压在急性卒中患者中经常出现，且与较差的预后相关。然而，在卒中发作后的院前阶段启动降压治疗是否能改善未分化急性卒中患者的预后仍不确定。
我们检索了PubMed、Embase和Cochrane数据库，以识别调查假定超急性卒中（在<6小时内）院前降压干预措施的随机对照试验。分析的主要结局是90天改良Rankin量表（mRS），而死亡率被视为次要结局。
该荟萃分析纳入了四项研究，共3912例患者。汇总数据显示，接受降压治疗的组与对照组或安慰剂组在90天时的不良功能结局（RR = 0.97，95%CI：0.92 - 1.02）或死亡率（RR = 1.02，95%CI：0.90 - 1.15）方面无显著差异。
在假定超急性卒中患者中，卒中6小时内的院前降压治疗并未改善临床结局（国际前瞻性注册系统：CRD42024557505）。
